Publication:

A life threatening secondary postpartum haemorrhage due to AV malformation of uterus: a missed diagnosis

In current practice, the incidence of c section and other pelvic surgeries has been risen steadily worldwide, so is the complications of surgeries one such rare complication is "AV malformation". The classical presentation of uterine AVM is recurrent profuse vaginal bleeding. Presence of retained product of conception can cause diagnostic dilemma and clinical presentation could be similar. We presented a case report of 19 year old primigravida with secondary post-partum hemorrhage, 1 month following caesarean section. USG shows RPOC so patient was managed conservatively and discharge. Again she had massive bleeding per vaginum on Post LSCS day 57, was re-admitted, as the patient was hemodynamically unstable to save her life hysterectomy was performed, patient  condition improved and was discharged successfully but at the cost of her fertility. HPR showed ‘vascular lesions in lower uterine segment’. Uterine AVM could present in a variety of ways from asymptomatic to periodic or episodic vaginal bleeding or secondary PPH to life threatening torrential vaginal bleeding. The proper diagnosis of AVM is crucial because the primary treatment modalities for the alternative diagnosis of RPOC is dilation and curettage that can worsen the condition. In past AVM were difficult to diagnose. However, availability of Doppler USG scanning has made diagnosis of AVM more feasible. Prompt resuscitation, a high index of suspicion and timely treatment is essential for avoiding a catastrophic outcome in this situation.